Review warns that risks of long term HRT outweigh benefits
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7366.673 (Published 28 September 2002) Cite this as: BMJ 2002;325:673
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In my view, the WHI and other trial reviewed have only muddied the
waters re the long-term benefits of HRT used early and for preventative
reasons. We can only slow life's time clock, not stop it, let alone turn
it back.
These other studies in the main contained too many older women for
whom too much precious time had been lost. When they started recruiting,
they were seeking to not only prove preventative benefit, but possibly
reversal of damage. The studies have now at least proven this does not
happen.
In the case of WHI, too many were more than 10 years into the
menopause, and too many were overweight as well. Also, as we know the
breast, and therefore the breast tumors, are eostrogen dependent tissues,
we could expect more to show up early in the study in the treated group, -
but would they have levelled out if they had gone on longer? That's the
question. We know they tend to do better than the non HRT controls. How
do we explain that?
We need a study with more recruited at the beginning of menopause,
and carried on to 8-10 years before we will really know the full story.
Medical Research Council, please take note.
Competing interests: No competing interests
Premature ovarian failure an exception?
The WHI initiative, which is by far the largest study carried out,
does not refer to women whose risks of cardiovascular problems(untreated)
is considerably greater than the average menopausal women, and would
appear frightening for women with Turner's syndrome or other causes of
premature ovarian failure.
The normal guidelines for these women is to use transdermal oestrogens and
oral progestins rather than the conjugated equine products so favoured in
America. Their need for replacement therapy is high and I would welcome
further opinions on this topic.
Competing interests: No competing interests